Privacy Policy

CONSENT OF TREATMENT, BILLING, AND NOTICE OF PRIVACY PRACTICES

WINK EYECARE BOUTIQUE,LLC

1095 Seven Locks Rd, Potomac, MD 20854

I, the undersigned, authorize Wink Eyecare Boutique, LLC to release any information including the diagnosis and the records of any treatment or examination rendered to me or my dependents during the period of such eye care to third party payers and other health practitioners involved in my care. I authorize and request my insurance company to pay directly to Wink Eyecare Boutique, LLC all insurance benefits otherwise payable to me for services rendered. I understand that my eye care or medical insurance carrier may pay less than the actual bill for services. I agree to be responsible for payment of all services rendered on my behalf or my dependents. Service charges of 1 1/2 % per month will be added to all balances over 60 days past due. In the event it becomes necessary to collect a balance through litigation or a collection agency, I agree to pay all collection fees, and attorney’s fees incurred. I further authorize the use of this signature on all insurance submissions

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

We are committed to maintaining the privacy of your protected health information (“PHI”). We are legally required to record information about your health condition and the care and treatment you receive here, and this record-keeping is critical to your safety. This Notice details how your PHI may be used and disclosed to third parties. It also reviews your rights regarding your PHI.

Our records are electronic and can be accessed only by the doctor and staff via password entry. We do not send records by email without encrypting them to prevent their being read by parties other than the intended recipient. You have the right to see the records that we keep about your care.

We may disclose your PHI to other parties, without a separate consent for its release, in the following situations: 1) to other doctors and health care providers who are already treating you with your consent, or to whom you are being referred as part of our explicit plans (you will know when this is going to occur); 2) to third party payors (e.g. Medicare or your insurance company) in order for you to receive the coverage benefits that pay for your care; 3) to various third parties who are monitoring the quality of the care you receive, as required by law; and 4) to our business associates such as billing services.

The Practice may also disclose your PHI, without a written Consent from you, in the following additional instances: 1) De-identified information that does not identify you and, even without your name, cannot be used to identify you; 2) To a business associate if we obtain satisfactory written assurance, that they will appropriately safeguard your PHI; 3) To a person who, under applicable law, has the authority to represent you in making decisions related to your health care; 4) for the purpose of obtaining or rendering emergency treatment; 5) To a government authority if the Practice is required by law to make such disclosure regarding physical abuse or neglect; 6) To agencies charged with Health Oversight Activities, as required by law, including criminal investigations; 7) In response to a court order or a lawfully issued subpoena; 8) to a law enforcement official under certain circumstances; 9) To a coroner or medical examiner for the purpose of identifying you or determining your cause of death; 10) To an entity to whom you have agreed to donate your organs; 11) To prevent or lessen a serious and imminent threat to the health or safety of a person or the public (to an individual who is reasonably able to prevent or lessen the threat); 12) To the Workers’ Compensation system.

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Testimonials

Always love going to Wink! Their service and frame selection are excellent. The staff is so knowledgeable and so helpful in selecting just the perfect frame for your face. The only place I will shop for eyewear....

- Connie M, Potomac

5

My daughter and I both got glasses here. We had terrific experiences. The technicians are wonderful. There is no puff test. They have advanced technology for the exam. Dr. Rachel is wonderful. There is a range of frames in terms of price. Very highly recommend!...

- Anonymous, Potomac

5

I found Dr. Cohn and the people at Wink Eyecare Boutique to be extremely friendly and professional. They have the latest equipment for eye testing which is quick and efficient and Dr. Cohn took the time to thoroughly test my eyes and explain everything to me. I would definitely recommend...

- Sarah C, Potomac

5

Wink was strongly recommended to me by a friend. Tucked in a shopping center where I would never have seen it -- very grateful to be directed to Wink by someone I trust. It is top notch and efficient on the technological side (eye exam expertise; both the equipment and...

- Carol S, Potomac

5

Came to Wink on a friend's recommendation for a long-overdue eye exam. Dr. Cohn is wonderful - very professional, thorough, and knowledgeable. I ended up getting fitted for new contact lenses and they were very honest about the cost and process. Dr. Cohn had me do a trial and then...

- Sarika P, Potomac

5

Amazing. Everyone is so helpful and friendly. They are truly looking out for your best interests. Dr. Cohn is excellent, She uses the latest technology and it’s very reassuring to know I received a very thorough exam. The selection of frames is the best in town and the optical staff...

- Amy G, Potomac

5

Great care (both in exam and shop), and friendly, helpful, knowledgeable, and nonpushy advice as always. Been coming for years!...

- Michelle W, Potomac

5

Dr. Cohn is the greatest eye doctor ever!!!! Books in 30-minute increments so you never feel like you are in a factory and she has the best up to date equipment to ensure eye health and deliver super sharp vision correction. The staff, frames and facilities are all top notches! So glad...

- Anonymous, Potomac

5

The whole staff is just amazing. Kim who works at the front desk knows everyone by name. Dr. Cohn is an amazing optometrist with the very newest high tech machines to examine your eyes without having to be dilated!!...

- Andrea M, Potomac

5

As always Dr. Cohn gives an excellent and thorough eye examination. The staff is knowledgeable and friendly. I have been coming to Wink for many years for all of my vision needs....

- Anonymous, Potomac

5

My experience at Wink was well above what I expected. The staff and Dr. Cohn were extremely helpful answering all my questions and helping me with picking out glasses. Dr. Cohn walked me through all of my options and their state of art machines made my eye exam easy. Well...

- Leslie P., Rockville MD

5

Dr. Cohn provided a detailed eye exam, explaining what she was doing and why. Kim provided excellent advice on styles/colors of frames for both everyday wear glasses and sunglasses. Her advice is always spot on! My family has followed her for 26 years... she is the best!...

Eye health tips for students from our Potomac eye doctor The start of fall means back-to-school for kids of all ages – and our team at Wink Eyecare Boutique wishes everyone a smooth and successful return to the classroom! When your child enters school after a summer of outdoor fun,...

This summer, heat waves with scorching temperatures have hit communities nationwide, making an already hot summer even hotter. With high temps and heat waves in certain areas, it’s now more important than ever to protect yourself. For best practices and tips for maintaining healthy vision in the summer heat, talk...

You know how you feel when you don’t get enough sleep – cranky, foggy, dragging through the day? And your eyes may be red and puffy with black bags underneath. But not only does lack of sleep affect the appearance of your eyes, it can also interfere with your eye...

Looking for an eye doctor in Rockville? Visit us!

For over a decade, Wink Eyecare Boutique has continuously provided fashionable eyewear and comprehensive eye care in Potomac, MD. Not only has our eye doctor, Dr. Rachel Cohn, helped patients of every age achieve healthy clear vision, but our team continues to bring expertise and unmatched care for anyone looking for an optometrist.